Epidemiologist Eric Feigl-Ding was on Twitter yesterday, waning about the COVID becoming a chronic disease with severe neurological problems after patients are "cured." He reports that between 10 and 35% of survivors suffer disabling, persistent neurological symptoms. From the study he cited: "While the pulmonary complications have received the most attention, it is the neurological manifestations that are disabling, persistent and common in patients infected with SARS-CoV-2. The entire neuro-axis can be involved resulting in a wide variety of manifestations. While the pathophysiology is not well understood, many of the clinical manifestations seem to be immune mediated. The socio-economic consequences of these complications are dire."
Nearly one third of hospitalized patients with COVID-19 develop encephalopathic symptoms. These can range from alteration in consciousness to delirium and seizures in some. Patients with altered mental status are hospitalized for three times as long and two-thirds are unable to manage activities of daily living at the time of discharge... [O]thers have intrathecal synthesis of antibody. A cytokine release syndrome in which patients develop confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism has also been described. These patients respond to corticosteroid therapy. Some others may develop widespread microcerebral hemorrhages.
...Delirium for patients with COVID-19 has been especially common. Rarely it is present at onset and typically associated with sepsis, but it is otherwise seen in the critical care setting where causes are multifactorial. In one series 84% of COVID-19 patients in the ICU had delirium with a combination of acute attention, awareness, and cognition disturbances.
...Following the acute phase and sometimes during the acute phase, a variety of immune mediated syndromes can occur which can affect the brain, spinal cord or peripheral nerves. Such syndromes have been described with other viral infections and it is unclear at present if the manifestations with SARS-CoV-2 are in any way different. Acute disseminated encephalomyelitis has been reported with multifocal inflammatory lesions in the brain, spinal cord and optic nerve.
...Most concerning however are the long-term complications of the viral infection. Nearly 10-35% patients continue to complain of persistent symptoms most of which are neurological in nature. This compilation of symptoms has been termed, Long-Haul COVID or Long COVID. Often these symptoms can first manifest after the acute phase of the illness. The severity of the acute phase does not predict the development of this syndrome either. The manifestations are very similar to myalgic encephalomyelitis/chronic fatigue syndrome. These patients complain of extreme exercise intolerance, dysautonomia, sleep disturbances, pain syndromes, low grade fever, dizziness, dyspnea and cognitive difficulties. Autonomic dysfunction can include palpitations, or tachycardia upon mild exercise or standing, hypo- or hypertension, gastroparesis, constipation or loose stools and peripheral vasoconstriction. In one series of hospitalized patients, 55% complained of fatigue and 34% complained of memory loss post-discharge.
Saturday, the U.S. reported 145,528 new cases. Sunday is was 138,096 new cases. And today, 161,568 new cases. The U.S. now has a total of 13,919,870 who have or have had COVID. 274,332 have died. There are 42,054 cases per million Americans. The worst hit states are the largely maskless Dakotas. North Dakota reports 103,997 cases per million residents and South Dakota is catching up-- 90,955 cases per million. Considering the after-effects cited above, I'd be taking visiting the Dakotas off my bucket list.
While not doing nearly as horrific as their neighbors in the Dakotas, Iowa and Nebraska-- thanks in large part to vigilant Democratic Governor Laura Kelly, who has been hampered by a COVID-freiendly Republican state legislature-- Kansas is not getting off easily. There are currently 159,189 cases, which translates to a horrible 54,642 cases per million residents. Last week, NPR reported that when "researchers analyzed coronavirus infection rates in Kansas following a statewide mask mandate, they found that counties that chose to enforce the mandate saw their cases decrease. Counties that chose to opt out saw their cases continue to rise." Among the findings:
The Kansas mask requirement went into effect on July 3, when coronavirus cases were rising across the state. But 81 counties opted out of the mandate, as permitted by state law. The other 24 counties-- which account for the majority of the state's population-- chose to require that masks be worn in public places.
The CDC and the Kansas Department of Health and Environment analyzed trends in county-level cases before the mandate went into effect and two months afterward. Though rates were considerably higher in the 24 counties that required masks, over the two-month study period they brought the growth of cases under control and even reduced them. The counties that didn't require masks continued to see their cases increase.
On average, the counties that required masks saw a 6% reduction in cases (calculated as a seven-day rolling average of new daily cases per capita). In contrast, the counties that opted out saw a 100% increase.
Along with other mitigation strategies including physical distancing and hand washing, "the decrease in cases among mandated counties and the continued increase in cases in nonmandated counties adds to the evidence supporting the importance of wearing masks," the CDC says.
